Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium

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Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Healthcare Infrastructure
Understanding the opportunity
for institutional investors
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Contents
Foreword                                       4
Executive Summary                              5
The investment opportunity                     8
   How is Healthcare
   Infrastructure performing?                  10
Challenges and drivers                         11
   What is driving institutional demand?       12
   What are the challenges and how
   can they be addressed?                      14
   Institutional investors see beyond Brexit   16
Unlocking potential:
how institutions are investing                 17
   Europe: will it remain the leading light?   18
   ESG: an investment priority?                19
Conclusion                                     20
Methodology                                    21
About us                                       22

Healthcare Infrastructure                           2   Understanding the opportunity for institutional investors   3
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Foreword                                                                                                                                   Executive Summary
Demand for Healthcare Infrastructure from institutional investors                                                                          Our research reveals growing interest in Healthcare Infrastructure,
is growing, with the potential for $200 billion to be invested in the                                                                      with unprecedented new opportunities being driven by market
sector over the next five years.                                                                                                           dynamics and global demographic changes.

In our first institutional investment trends                                      opportunity in retirement communities, care              KEY FINDINGS                                                                  Among those that already invest in
survey, we explore the views on the sector                                        homes and doctors’ surgeries – the facilities                                                                                          Healthcare Infrastructure allocations are
of 100 global institutional investors,                                            that this varied ageing population will need             Healthcare Infrastructure: global demand on the rise                          significant. Respondents already invested

                                                                                                                                           $200 billion
representing a total of $6.8 trillion assets                                      the most.                                                                                                                              in the sector allocate on average 6.1% of
under management, including the drivers                                                                                                                                                                                  their investment portfolio to Healthcare
shaping opportunity in the sector.                                                Our report also explores the perceived                                                                                                 Infrastructure. And this investment is set to
                                                                                  barriers some institutional investors face                                                                                             increase by more than half to 9.5%.
MARKET DYNAMICS                                              By 2050, the         when looking to make further investment
                                                             global population                                                             expected to be invested over the next five years
The expected end of the bull market,                                              in Healthcare Infrastructure.                                                                                                          Barriers to investing remain, but the research
compounded by heightened political risk                      of retirees aged                                                                                                                                            reveals growing momentum both from
                                                             60 and over
across the globe, makes alternatives an                                           The research highlights that institutions are                                                                                          current investors and from those who are yet
                                                             will reach 2.1
attractive investment opportunity for                                             particularly concerned about not having                                                                                                to allocate to Healthcare Infrastructure.
                                                             billion and will
investors in the hunt for returns.                                                the relevant skills and resources within their
                                                             include an elderly
                                                             population of 425    organization, regulatory issues in the sector                                                                        9.5%              Diversification and demographics
Within the 'alternatives' bucket, there
is growing interest from institutional
                                                             million people
                                                             aged over 80.1
                                                                                  and a lack of projects in which to invest. We
                                                                                  have seen some of these concerns brought                             6.1%                                                              drive demand

investors in real assets as they look for                                         to life through our conversations with                                                                                                 The bull market looks to be running out of
tangible investment opportunities with a                                          institutional investors over the years.                                                                                                steam and political uncertainty is now a
long-term investment horizon. Healthcare                                                                                                                                                                                 global concern. Healthcare Infrastructure
Infrastructure, as a subsector of real assets,                                    There is a meaningful role and exciting                           Current average                           Anticipated average        is attractive in this context as it is
offers particular opportunities for institutions                                  opportunity for institutional investors to                     portfolio allocation of                      portfolio allocation       sheltered from macroeconomic factors.
as changing demographics fuel demand to                                           redefine what truly exceptional healthcare                   institutional investments.                           by 2023.             The supply/demand imbalance for quality
service a growing elderly population.                                             facilities should look like, while benefiting                                                                                          accommodation and facilities to cater to
                                                                                  from the attractive returns the asset class              Healthcare Infrastructure: delivering for institutions                        the ageing population is the second biggest

                                                                                                                                           71%                                                                                                  56%
DEMOGRAPHICS                                                                      offers investors over the long term.                                                                                                   driver for investors.
Octopus is a specialist asset manager with 14
years’ experience of investing in Healthcare                                      We look forward to sharing our findings
Infrastructure. We have seen first-hand                                           with you.
how demand for all kinds of Healthcare                                                                                                     Global institutional investors say their                                                           of institutional investors
Infrastructure is changing in line with these                                     Benjamin Davis                                           Healthcare Infrastructure investments                                                          surveyed say demographics
demographics.                                                                     CEO, Octopus Healthcare                                  are performing as expected or better                                                          is the key driver for investing
                                                                                                                                           than expected.                                                                                in Healthcare Infrastructure.

                                                                                                                                                                                                  22%
Retirement for the growing population is
taking on a different shape and meaning
to previous generations. Quality of life is                                                                                                                                                                              Europe is the primary focus for
                                                                                                                                       £
better, and the modern-day retiree is active                                                                                                    £                                                                        inward investment
and social.                                                                                                                                £                                            UK institutional investors say
                                                                                  Hiti Singh                                                                                          their Healthcare Infrastructure    Of the regions surveyed, the UK will attract
For the elderly, care homes suited to the                                         Head of Institutional Funds, Octopus Group                                                        investments are over-performing.     the most inward investment into Healthcare
specialist requirements of their residents                                                                                                                                                                               Infrastructure over the next five years, from

                                                                                                                                           10-15%
are crucial. The supply of housing for each                                                                                                                                                                              those who are yet to invest. Europe is the
of these groups is in short supply. In this                                                                                                                                                                              primary focus for inward investment into
report we specifically look at the investment                                                                                                                                                                            Healthcare Infrastructure.
                                                                                                                                           Annualised net IRR reported by 39%
1
    World Population Ageing Report (2017), United Nations.                                                                                 of investors over the past five years.

Healthcare Infrastructure                                                                                                          4       Understanding the opportunity for institutional investors                                                                     5
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Stirling Medical Centre,
Grimsby. A doctor's surgery
including an on-site pharmacy.

                                 Our survey respondents currently allocate
                                 6.1% of their investment portfolio to the
                                 Healthcare Infrastructure sector. In the
                                 next five years over a third (37%) expect to
                                 increase their allocations by up to 10%.
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
The investment opportunity                                                                                                                                                                                                                               Grosvenor Manor Care
                                                                                                                                                                                                                                                         Home, Chester. Facilities
                                                                                                                                                                                                                                                         include a hair salon, spa
                                                                                                                                                                                                                                                         bathroom, landscaped
The investment case for Healthcare Infrastructure is already resonating                                                                                                                                                                                  gardens and glazed terraces.

with institutional investors. Across region and investor type there is demand
for opportunities to allocate funds to the sector.

In the next five years, a total of $200                    Over a third of respondents expect
billion could be invested in Healthcare                    to increase allocations to Healthcare
Infrastructure.                                            Infrastructure by up to 10% in the next five
                                                           years. Insurance companies will increase
Globally, respondents currently invested in                their allocations more than any other type
Healthcare Infrastructure allocate 6.1% of                 of investor in the next five years, with a 4.4%
their investment portfolio to the sector. This             increase in allocation.                                                                                                                                                                       Institutional
is expected to increase by more than half to                                                                                                                                                                                                             investors
9.5% over the next five years.                                                                                                                                                                                                                           expected future
                                                                                                                                                                                                                                                         allocation by

                                                                                                              37%
                       Figure 1. Current and future allocation to Healthcare Infrastructure
                                                                                                                                                                                                                                                         asset:
                                        across region and by investor types                                                                        Figure 2. Percentage of institutions considering investing in Healthcare Infrastructure

                                                                                                                                                                                                                                                             57%
                                                                                                              of respondents                                                Fund of
                                                                                                                                                                                            HNW
                                                                                                                                                                                                       Pension     Private       Insurance   Strategic
                               6.1%                                                 6.3%                      expect to increase                               Global                      family
                                                           Fund of Funds                                                                                                     funds                      fund        bank         company      investor
     Global                                                                                      10.1%                                                                                     office
                                          9.5%                                                                allocations to                                                                                                                                    Retirement
                                                                                                              Healthcare           Retirement housing            57%          28%           90%          50%         61%           74%         61%
                                                                                                                                                                                                                                                                 housing
                                                           HNW family       2.9%                              Infrastructure by    Care homes                    53%          32%           83%          63%         67%           47%         56%
                            4.1%                           office                     6.9%                    up to 10% in the
     Australia                                                                                                                     Doctor surgeries             44%           56%           44%          41%          6%           28%         70%
                                          9.4%                                                                next five years.
                                                                              3.8%                                                                                               % Would consider investing

                                                                                                                                                                                                                                                             53%
                                                           Pension fund
                                                                                         7.8%
                                           10.6%
     Asia                                                                                                                          GLOBAL ALLOCATIONS: ASIAN                                      Australian investors plan to increase investment
                                                 12.1%                                                                                                                                                                                                         Care homes
                                                                                   5.7%                                            INVESTORS LEADING THE CHARGE                                   by the biggest margin. Although Australian
                                                           Private bank
                                                                                              8.6%                                 Asian respondents revealed the highest                         investors have a relatively low current allocation
                            4.5%                                                                                                   level of current allocations to Healthcare                     at 4.1%, this is expected to increase by 5.3%
     EMEA
                                   6.9%                    Insurance                    7.1%                                       Infrastructure (10.6%) and will invest the                     (compared to a global average of 3.4%) over

                                                                                                                                                                                                                                                            44%
                                                           company                                   11.5%                         most into the sector of any other region                       the next five years to 9.4%.
                                                                                                                                   in the coming years. They expect 12.1% of
                              5.8%                                                                                                 their portfolio to be allocated to Healthcare                  A large majority of UK respondents (73%)                       Doctors'
     UK                                                    Strategic                           9.7%
                                                                                                                                                                                                                                                                 surgeries
                                          9.6%             investor                                   12.5%                        Infrastructure in the next five years.                         say they will increase allocations. One quarter
                                                                                                                                                                                                  (26%) plan to do so by more than 10%.

                                                 Current           Future
                                                                                                                                                                Figure 3. Increasing allocations to Healthcare Infrastucture

                                                                                                                                                                  Global            Australia           Asia             EMEA                UK
There is strong appetite for a range of assets             Retirement housing holds particular appeal                              Increase by > 20%                8%                14%                0%                0%                13%
across the sector. Among all institutions                  to High Net Worth (HNW) family offices and
                                                                                                                                   Increase by 10-20%               11%               0%                20%                6%                13%
surveyed, 57% are considering investing                    insurance companies, while care homes are
in retirement housing, 53% are potentially                 most in demand among HNW family offices                                 Increase by up to 10%           37%                29%               20%                31%               47%
looking to invest in care homes and nearly                 and private banks.                                                      Stay the same                   32%                43%               60%                38%               18%
half (44%) in doctors’ surgeries.                                                                                                  Don’t know                      12%                14%                0%                25%               9%

Healthcare Infrastructure                                                                                                      8   Understanding the opportunity for institutional investors                                                                                        9
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Hirwaun Medical Centre,
                                                                                                                                                                                                                                 Mid Glamorgan.
How is Healthcare Infrastructure performing?                                                                                                                                                                         A doctor's surgery including
                                                                                                                                                                                                                           an on-site pharmacy.

In the current environment, where institutions are chasing returns
from bonds and equities, Healthcare Infrastructure has the potential
to offer attractive returns over the long term.

                                                                                                                              Challenges and drivers
Investors in Healthcare Infrastructure                    INVESTORS BULLISH ON FUTURE
report high satisfaction with investment                  PERFORMANCE
performance. Almost four in ten (39%)                     Investors surveyed are bullish and expect                           Investor appetite for Healthcare Infrastructure is growing, driven by
report an annualized net IRR on Healthcare                higher returns. Four in ten (42%) expect net                        the race to alternatives, opportunities from the ageing population
Infrastructure investments over the past five             returns over the next five years to be in the                       and the long-term nature of the investments.
years of between 10% and 15%. A further                   range of 10%-15%. And 12% expect future
5% say their returns over the period were                 returns of between 15%-20%. Globally,                               Despite this growing interest and high allocations among current investors in
between 15%-20%. These figures equate to                  investors expect 10% returns on average.                            the sector, respondents identify a number of perceived barriers to unlocking
a global average of 8%.                                                                                                       further potential in the sector. Barriers include regulation, a lack of projects and
                                                          Asian investors are the most optimistic                             relationships with operators.

                                                                                                          10-15%
Seven in ten (71%) global institutional                   about future returns, expecting 13% returns
investors say their Healthcare Infrastructure             on average.
investments are either performing as                                                                      net returns
expected (52%) or over-performing (19%).                                                                  expected by 42%
UK investors report the strongest levels of                                                               of investors
satisfaction. Nearly one quarter (22%) say                                                                surveyed over the
their investments are over-performing.                                                                    next five years.

                  Figure 4. Past and expected investment returns from Healthcare Infrastructure

                                    Global                                              EMEA
     Below 10%                    35%           37%       Below 10%                   31%         36%
     10% to 15%                   39%           42%       10% to 15%                  50%         44%
     15% to 20%                    5%           12%       15% to 20%                   0%         12%
     20% to 25%                    0%            3%       20% to 25%                   0%          0%
     More than 25%                 3%            0%       More than 25%                0%          0%
     Don’t know                   18%            6%       Don’t know                  19%          8%

                                  Australia                                              Asia
     Below 10%                    43%           20%       Below 10%                  30%          20%
     10% to 15%                   57%           70%       10% to 15%                 50%          47%
     15% to 20%                    0%           10%       15% to 20%                  0%          27%
     20% to 25%                    0%            0%       20% to 25%                  0%          6%
     More than 25%                 0%            0%       More than 25%               0%          0%
     Don’t know                    0%            0%       Don’t know                 20%          0%

                                      UK
     Below 10%                   38%           46%
     10% to 15%                  25%           34%
     15% to 20%                    9%            8%
     20% to 25%                    0%            4%
     More than 25%                 6%            0%           Past return
     Don’t know                   22%            8%           Expected return

Healthcare Infrastructure                                                                                                10
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
What is driving institutional demand?                                                                                                                           Figure 5. Drivers for Healthcare Infrastructure by region

                                                                                                                                                                      Global            Australia          Asia             EMEA                 UK
Institutional investors surveyed identify                                                                                   Diversification/low correlation
                                                                                                                                                                        67%                  71%           100%                69%               55%
                                                                                                                            with financial markets
three key investment drivers.                                                                                               Investment opportunities
                                                                                                                            from ageing population                      56%                  57%            70%                56%               52%

                                                                                                                            Attractive risk-adjusted returns            46%                  57%            10%                69%               43%

                                                                                                                            Long-term yields/income                     38%                  57%            30%                19%               46%
                                                                                                                            Stable and predictable
1. Race to alternatives as market                                    3. Chasing returns and long-term income                                                            30%                  57%            10%                38%               26%

                                                                                                                                                                                                                                                             67%
                                                                                                                            cash flows
volatility continues                                                 Attractive risk-adjusted returns rank highly           Gain exposure to alternative
                                                                                                                            real estate                                 28%                  0%             60%                19%               30%
A combination of diversification and the                             for institutional investors, with nearly half
sector’s low correlation with broader                                (46%) of global respondents considering                ESG/Impact investing*                        17%                 0%             0%                 19%               26%
                                                                                                                                                                                                                                                             of investors
financial markets emerges as the prime                               this the third-biggest driver.                                                                     14%                  0%             20%                13%               17%
                                                                                                                            Inflation hedging
                                                                                                                                                                                                                                                             surveyed cited
driver, cited by two-thirds of respondents.
                                                                                                                                                                                                                                                             diversification
                                                                     Another important driver, cited by almost

                                                 56%
                                                                                                                                                                                                                                                             and the sector's
Respondents recognise that returns from                              four in ten respondents (38%), is the long-                                     Figure 6. Drivers for Healthcare Infrastructure Investment by investor type
                                                                                                                                                                                                                                                             low correlation
Healthcare Infrastructure are mostly                                 term nature of yields/income. Doctors’                                                                        Fund of    HNW family   Pension   Private         Insurance   Strategic   with financial
                                                                                                                                                                    Overall
                                                                                                                                                                                    Funds       office      fund      bank           company      investor
uncorrelated to traditional asset classes                            surgeries and care homes can present a long-                                                                                                                                            markets as a
                                                 of institutional                                                           Diversification/low correlation
and financial markets.                                               term income-led investment opportunity.                with financial markets                   67%            46%            33%      75%      100%              75%        55%        key driver.
                                                 investors say
                                                                                                                            Investment opportunities
                                                 demographics                                                               from ageing population                   56%            62%            67%      63%      33%               38%        64%
This is becoming increasingly important          is the key driver   This correlates with the long-term focus of
for investors as they look to recession-                             institutional investors who use asset-liability        Attractive risk-adjusted returns         46%            62%            33%      44%      22%               75%        45%
                                                 for investing
proof portfolios amid a volatile investment      in Healthcare       matching and inflation hedging to manage               Long-term yields/income                  38%            38%            0%       38%      67%               25%        45%
backdrop.                                        Infrastructure.     interest rate risk.                                    Stable and predictable
                                                                                                                            cash flows                               30%            23%            60%      44%       11%              25%         27%
                                                                                                                            Gain exposure to alternative
On a geographical basis, Asian respondents                           Private banks (67%) are more likely to be              real estate                              28%            31%            67%      25%       11%              13%         27%
attach particularly strong importance to                             driven by long-term yields/income than any             ESG/Impact investing*                    17%            31%            0%       13%      33%               0%          18%
diversification. All investors (100%) from the                       other type of investor.
region say this is the most important driver.                                                                               Inflation hedging                        14%            8%             0%       0%       22%              50%          18%

                                                                                                                            For example, alleviating housing crisis, helping NHS
                                                                                                                            *

2. Opportunities from the ageing
population                                                                                                                                                                                                                                                   Opposite: Lifecare
A majority (56%) of global investors cite                                                                                                                                                                                                                    Residences, Battersea
                                                                                                                                                                                                                                                             Place, London. Featuring an
investment opportunities from demographics                                                                                                                                                                                                                   array of five-star facilities
                                                                                                                                                                                                                                                             including chef-led restaurant,
as the second most important driver.                                                                                                                                                                                                                         concierge, chauffeur service,
                                                                                                                                                                                                                                                             pool and cinema.

Increasing life expectancy and declining                                                                                                                                                                                                                     Left: Wadswick Green,
                                                                                                                                                                                                                                                             Wiltshire. Facilities include
fertility will cause the average age of the                                                                                                                                                                                                                  a spa, pool, gym and open
global population to increase significantly                                                                                                                                                                                                                  countryside.

in the coming years.

Ageing populations and a lack of good
quality retirement housing, doctors’ surgeries
and care homes to cater to this group have
fuelled demand for Healthcare Infrastructure.

These investment dynamics are sustainable.
Demand for Healthcare Infrastructure will
increase as the world’s population continues
to age.

Healthcare Infrastructure                                                                                              12   Understanding the opportunity for institutional investors                                                                                                        13
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
What are the challenges and how                                                                                                                                                  Figure 7. Challenges to investing in Healthcare Infrastructure by region

                                                                                                                                                                                  Global                Australia                Asia                    EMEA                      UK
can they be addressed?
                                                                                                                                       Lack of investor skills*                       45%                    40%                 53%                        32%                   50%
                                                                                                                                       Governmental/regulatory
                                                                                                                                       barriers                                       44%                    40%                 53%                      44%                     42%

                                                                                                                                       Liquidity issues                               43%                    20%                 47%                      44%                     46%
Lack of resources and the role of                  market for certain forms of healthcare,
                                                                                                                                       Lack of project pipelines                      38%                    40%                 53%                      48%                     28%
specialist managers                                including care homes, is in fact very liquid
Almost half (45%) of respondents cite a            for quality stock. Healthcare real estate                                           Costs                                          34%                    30%                 40%                      20%                     40%
lack of investor skills and resources within       investment tends to involve longer fund                                             Corporate-governance issues                    33%                    40%                 27%                      28%                     36%
their organisation as the top challenge when       tenure, but this is to suit investors with long-
                                                                                                                                       Organisation’s investment
investing in Healthcare Infrastructure. This       term investment horizons.                                                           committee restrictions                         28%                    10%                 33%                      36%                     26%
internal challenge highlights the need for                                                                                             Cash flow volatility                           11%                    0%                   7%                          8%                   16%
organisations with insufficient resources to       Lack of projects and developing
                                                                                                                                       Poor returns                                   10%                    10%                  0%                      20%                      8%
outsource to specialist investment managers.       a stronger pipeline of opportunities

                                                                                                      45%
In particular, organisations should look for       More than one third (38%) of respondents
managers with the origination capabilities         say a lack of pipeline of projects is acting                                                                              Figure 8. Challenges to investing in Healthcare Infrastructure by investor type
to pick the best assets and a track record in      as a barrier. This could be a function of the
                                                                                                      of investors cite                                                         Overall      Fund of Funds
                                                                                                                                                                                                               HNW family
                                                                                                                                                                                                                              Pension fund     Private bank
                                                                                                                                                                                                                                                                   Insurance
                                                                                                                                                                                                                                                                                Strategic investor
delivering robust returns.                         sector’s recent growth and consequent                                                                                                                         office                                            company
                                                                                                      a lack of skills
                                                   shortage of investable projects. Investors with                                     Lack of investor skills*                  45%             53%               33%           58%              70%                40%              14%
                                                                                                      and resources
Healthcare Infrastructure is a highly-             an in-house development team have the              within their own                 Governmental/regulatory
                                                                                                                                       barriers
                                                                                                                                                                                 44%             42%               50%           33%              20%                47%              71%
specialised area requiring specialists             advantage of being able to generate an off-        organisation as
with large resources to carry out a range          market stream of assets for funds.                                                  Liquidity issues                          43%             53%               42%           25%              60%                60%              21%
                                                                                                      the top challenge
of functions. These include identifying                                                               when investing                   Lack of project pipelines                 38%             21%               25%           58%              20%                47%              43%
development opportunities, undertaking             Corporate governance and                           in Healthcare
                                                                                                                                                                                 34%             26%               42%           38%              30%                53%              14%
specialist demand/supply due diligence,            the relationship with operators                    Infrastructure.                  Costs

selecting the best operators and managing          A further third regard corporate governance                                         Corporate-governance issues               33%             32%               25%           42%              30%                33%              21%
these specialist assets.                           issues as an investment obstacle. This                                              Organisation’s investment                 28%             11%               17%           33%              20%                53%              29%
                                                   element underlines the important role of                                            committee restrictions

Regulatory barriers and making the case            stakeholder engagement in Healthcare                                                Cash flow volatility                      11%             11%               25%            0%              10%                7%               29%
for infrastructure investment                      Infrastructure.                                                                                                               10%             11%               0%            13%              10%                7%               14%
                                                                                                                                       Poor returns
The second-biggest challenge, cited by
44% of respondents, is governmental and            It is crucial to have good, long-term                                               Capablities/resources within my organisation
                                                                                                                                       *

regulatory barriers. Increasing regulation         relationships with operators, to ensure
and the changing role of public and private        oversight of an investment. It is preferential                                                                                                                                                                     Meads Medical Centre,
capital in infrastructure projects can create      to fund a steady stream of assets with             Audley Chalfont Dene,
                                                                                                                                                                                                                                                                      Uckfield. Doctor's
                                                                                                                                                                                                                                                                      surgery including an
uncertainties for investors.                       established and proven operators, rather           Buckinghamshire. Facilities
                                                                                                                                                                                                                                                                      on-site pharmacy.
                                                                                                      include a health club, library
                                                   than to fund one-off assets.                       and restaurant.

Government support and regulation will
vary across geographies, but there is a clear
benefit to governments globally supporting
investment into Healthcare Infrastructure.
Institutional investment will be a key source of
funding for the infrastructure needed to cater
to ageing populations. In the UK, institutional
investment into this type of infrastructure
has the potential to alleviate some of the
financial pressures on the NHS.

Liquidity issues and the nature
of longer fund tenure
Liquidity issues rank third, with 43% of
respondents citing this as a barrier. Yet the

Healthcare Infrastructure                                                                                                         14   Understanding the opportunity for institutional investors                                                                                                 15
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Monkseaton Medical
                                                                                                                                                                                    Centre, Whitely Bay.
Institutional investors see                                                                                                                                                     Doctor's surgery including
                                                                                                                                                                                    an on-site pharmacy.

beyond Brexit

While Brexit may present a concern in the                 More than half (58%) of global institutional
next 12 months, half of institutional investors           investors think Brexit will have a negative impact
surveyed have a long-term investment                      on Healthcare Infrastructure in the UK over
horizon between five and ten years. The                   the next 12 months. However, the UK remains
demographic dynamics underpinning
Healthcare Infrastructure will remain in place
                                                          the most attractive region for future inward
                                                          investment into Healthcare Infrastructure,
                                                                                                                                               Unlocking potential:
regardless of the UK’s departure from the
European Union.
                                                          among those not yet invested, suggesting
                                                          institutional investors see beyond Brexit.                                           how institutions are investing
                        Figure 9. Impact of Brexit on Healthcare Infrastructure in the UK

                             Global          Australia            Asia             EMEA           UK

Positive                      6%                 0%                0%                4%           10%
Neutral                       36%               90%               40%               28%           28%
Negative                      58%               10%               60%               68%           62%

                                                                                                               The Boulevard Medical
                                                                                                               Centre, Halifax.

                                                                                                               Highcroft Medical Centre,
                                                                                                               Nottinghamshire. Doctor's
                                                                                                               surgery including an on-site
                                                                                                               pharmacy.

Healthcare Infrastructure                                                                                                                 16
Healthcare Infrastructure - Understanding the opportunity for institutional investors - Fiduciary Investors Symposium
Europe: will it remain the leading light?                                                                                                                            ESG: an investment opportunity?
Europe is leading the way in attracting institutional funds into the sector.
A combination of cheap and easy access to debt, increasing levels of
privatisation and demographic dynamics have increased the investment
appeal of Healthcare Infrastructure in the region.

Demographic conditions are particularly                                          Figure 10. Healthcare Infrastructure investment by country                          Healthcare Infrastructure has a clear
favourable, with ageing populations                                                                                                                                  ethical and Environmental, Social and
creating a notable imbalance in the supply                                    UK                  Germany            France                  Japan                   Governance (ESG) dimension. Investing in
                                                                                                        5%                 3%                   8%             31%
and demand of good quality care homes                                                                                                                                care homes, retirement housing and doctors’
                                                                          15%
and retirement housing. For example, in                                                         21%                26%                          31%
                                                                                                                                                                     surgeries drives much-needed capital into
                                                                                                                            39%
Germany, Europe’s largest economy, more                                 25%        60%                   45%                            35%                          infrastructure that changes people’s lives
than 20% of the population is aged over 65.2                                                      29%                32%                       26%                   and improves the wellbeing of elderly people.

UK AS A HOT SPOT                                                          Australia          Nordic countries         Korea              Hong Kong                   Although institutional investors attach less
These dynamics have made Europe, and                                             9%                     10%                                                          weight to ESG than other investment-specific
especially the UK, an attractive place for                                                               25%
                                                                                                                     13% 17%               11% 17%                   drivers, it is still an important consideration.
                                                                                   30%
Healthcare Infrastructure investment.                                   32%
                                                                                                25%                                                                  Almost one in three investors surveyed say
                                                                                                                             25%         41%
                                                                                                                                                 31%
                                                                                29%                   40%
                                                                                                                   45%
                                                                                                                                                                     ESG considerations play a significant role
Six in ten global respondents already invested                                                                                                                       when investing in Healthcare Infrastructure.
in the sector say their organisation primarily                                                                                                                       A further 61% say it plays a slight role.
                                                                       New Zealand             South Africa       Latin America          Middle East
focuses on Healthcare Infrastructure                                             9%                     9%                    9%        9%           8%                                                                                                                                             Audley Chalfont Dene,
investments in the UK, with 45% prioritising                                    12%                     12%          12%                                             More than half of investors (56%) say they                                                                                     Buckinghamshire. Facilities
                                                                                                                                                                                                                                                                                                    include a health club, library
investment in Germany and 39% in France.                                                                                    23%                  25%                 are not willing to accept lower investment                                                                                     and restaurant.
                                                                        36%                               29%
                                                                                   43%          50%                 56%                  58%                         returns to achieve ESG/impact targets.
    60%
                                                    43%
                                                                                                                                                                                                                     Figure 12. Role of ESG in investing in Healthcare Infrastructure
                                                                                Currently a priority investment            Would consider investing
                                                                                + currently an investment
          26%                                                                   Would not consider investing               Not sure                                                                61%                                              57%                                     100%
                22% 21%

                             9%                                                                                                                                                      28%                                              29%
                                               5%                Figure 11. UK the
                                         3%
                                                                 focus of Healthcare                HOME BIAS                                                                                  Global          11%
                                                                                                                                                                                                                                                Australia     14%
                                                                                                                                                                                                                                                                                             Asia
                                                                 Infrastructure                     Notwithstanding the dominance of the UK, the
            Global                        Australia              investment
    60%                                                                                             research also reveals a degree of home bias.
                                   50%                                                                                                                                                                                                             59%
                47%                                                                                 Investors prefer to invest in their home market.                                                     44%                                                                            Significantly
                                                                                                                                                                                       50%
                                         41%                                                                                                                                                                                                                                            Slightly
                       35%                                                                                                                                                                                                            25%                                               Not at all
                                                                                                    In terms of potential future investment,                                                   EMEA            6%                                  UK
                                                                                                                                                                                                                                                              16%
          26%
                                               21% 22% 19%                                          several countries feature prominently
                             10%                                                                    on the radars of infrastructure investors.
                                                                                                    Respondents are mainly considering                                                                          Figure 13. Would you accept lower returns to achieve ESG targets?
                Asia                          EMEA                                                  investing in New Zealand (43%), the Nordic
    78%                                                                                             countries (40%) and France (32%), closely
                                                                                                    followed by Hong Kong (31%). The appeal
                                         UK                                                                                                                                                44%           56%                            24%             76%                        54%              46%
                                                                                                    of Hong Kong may in part reflect solid
                                         EMEA
                                         Asia                                                       healthcare fundamentals — the Chinese
          23%                            Australia &                                                province was ranked the most efficient                                                 All respondents                                  Not invested                            Already invested
                18%                      New Zealand
                       11%               Latin America                                              medical care system in the world by                                                                                                   Yes            No
                             6%
                                                                                                    Bloomberg in 2017.3
                UK

CIA World Factbook 2017.
2

https://largest-biggest.com/index.php/2017/05/15/bloomberg-most-efficient-health-care-systems-in-the-workd/
3

Healthcare Infrastructure                                                                                                                                 18         Understanding the opportunity for institutional investors                                                                                                   19
Conclusion                                                                                                                        Methodology

Encouraged by market dynamics and                Barriers to investing such as lack of resource                                   CoreData Research was commissioned by                       Disclaimer
demographic fundamentals, Healthcare             and regulation remain. Yet it is clear that                                      Octopus Investments to conduct a study of                   This report is issued by Octopus
Infrastructure has captured the attention of     investment in doctors’ surgeries, retirement                                     institutional investors to better understand                Investments Limited which is authorised
institutional investors around the world. The    housing and care homes is set to increase                                        their views about Healthcare Infrastructure                 and regulated by the Financial Conduct
research reveals the asset class is already an   considerably over the next five to ten years.                                    investments.                                                Authority. The information contained
attractive alternative investment for many                                                                                                                                                    within this report does not constitute an
institutions looking for opportunities in real   This investment will be crucial to ensuring                                      The fieldwork was conducted by CoreData                     offer or inducement to participate in a
assets. Among those that are invested in the     the ageing population receives the quality       Raynes Park Health Centre,      Research between September and October                      collective investment scheme, alternative
sector, portfolio allocations are high.          housing and care they will need – from           London. Doctor's surgery
                                                                                                  including an on-site hospital
                                                                                                                                  2018 via an online survey. The sample includes              investment fund or any other financial
                                                 retirees to the elderly.                         and pharmacy.                   100 respondents from the UK, EMEA, Asia                     product and may not be treated as an
                                                                                                                                  and Australia.                                              offer or inducement in any jurisdiction
                                                                                                                                                                                              where such an offer or inducement is
                                                                                                                                  The respondent pool represents a spectrum                   against the law, or to anyone to whom
                                                                                                                                  of organisations including pension funds,                   it is unlawful to make such an offer or
                                                                                                                                  fund of funds, insurance company, strategic                 solicitation, or if the person making the
                                                                                                                                  investors, family offices and private banks.                offer or solicitation is not qualified to do
                                                                                                                                  The total assets under management of the                    so. The value of investments, and the
                                                                                                                                  sample is an estimated $6.8 trillion.                       income from them, may fall or rise. The
                                                                                                                                                                                              information in this document should not
                                                                                                                                  Respondents were classified into two                        be construed as offering investment or tax
                                                                                                                                  broad categories according to their current                 advice. Issued: November 2018.
                                                                                                                                  allocations to Healthcare Infrastructure –
                                                                                                                                  those invested in Healthcare Infrastructure
                                                                                                                                  (65) and those not invested (35).

Healthcare Infrastructure                                                                                                    20   Understanding the opportunity for institutional investors                                              21
About us

OCTOPUS GROUP                                                                                                        COREDATA
Octopus is a group of companies that invests                                                                         Established in 2002, CoreData Research is
in the people, ideas and industries that                                                                             a global specialist financial services research
will help to change the world. We currently                                                                          and strategy consultancy with operations in
manage more than £8.6 billion on behalf                                                                              Australia, the UK, the Philippines, the United
of our customers. Octopus Energy, Octopus                                                                            States, Malta and Colombia.
Healthcare, Octopus Investments, Octopus
Labs, Octopus Property and Octopus                                                                                   With a primary focus on financial services,
Ventures are all part of Octopus Group.                                                                              CoreData Research provides clients with
                                                                                                                     both bespoke and syndicated research
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sectors of the economy. Our assets are long-                                                                         business-to-business and business-to-
term in nature, cash-yielding and are resilient                                                                      consumer research. Its offering includes
to economic headwinds. The Octopus team is                                                                           market intelligence, guidance on strategic
made up of over 125 investment professionals                                                                         positioning, methods for developing new
and we have almost two decades’ experience                                                                           business, advice on operational marketing
of operating in our chosen markets.                                                                                  and other consulting services.

OCTOPUS HEALTHCARE
Octopus Healthcare invests in and develops
properties as well as creating partnerships
to deliver innovative healthcare facilities
to improve the health and wellbeing of the
UK. It currently manages over £1.5 billion of
healthcare investments across a number of
platforms, with a focus on three core areas:
GP surgeries, care homes and retirement
communities.

Visit octopusgroup.com.

Healthcare Infrastructure                           22   Understanding the opportunity for institutional investors                                                     23
InstitutionalFunds@octopusinvestments.com   Octopus Group
                        octopusgroup.com                            33 Holborn
                                                                    London EC1N 2HT
Healthcare Infrastructure                                                             24
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